PB1748: LOW HAIR CORTISOL CONCETRANTIONS AT DIAGNOSIS OF CHILDHOOHD HEMATOLOGICAL MALIGNANCIES
Authors: Panagiota Kourou, Maria Moschovi, Nikos Vlachogiannis, Aimilia Mantzou, Margarita Baka, Maria Nikita, Dorothy Stathaki, Evangelia Charmandari
Journal: HemaSphere (2023)

Topic: 2. Acute lymphoblastic leukemia - Clinical Background: Cortisol, the main end-product of the hypothalamic–pituitary–adrenal (HPA) axis, plays an important role in basal and stress-related homeostasis. During acute stress, cortisol concentrations rise abruptly secondary to ACTH hypersecretion as part of the fight-or-flight response. During chronic stress, cortisol concentrations usually remain elevated, however, they lose their beneficial effect and can lead to a broad range of problems, including metabolic dysregulation and promotion of chronic disorders. Moreover, dysregulation of glucocorticoids can affect prognosis of cancer patients, through direct action of glucocorticoids on cancer cells affecting apoptosis or through suppression of immune responses. While cortisol concentrations are expected to be elevated in chronic inflammatory disorders, mainly due to the release of proinflammatory cytokines that stimulate the adrenal glands, a relative hyporesponsiveness of the HPA axis to cytokines is observed in some diseases and may underlie the increased susceptibility of such patients to acute stressors, such as infections. The integrity of the HPA axis in hematological malignancies, including its potential prognostic value, has not been extensively studied to date. Moreover, most studies use single-point measurement of cortisol, while the cumulative long-term systemic cortisol exposure is difficult to be evaluated. Aims: We investigated the concentrations of hair cortisol, as an indicator marker of stress, at diagnosis of children with hematological malignancies and the possible relation with the chronic stress of the disease. Methods: Consecutive, treatment-naïve pediatric patients, diagnosed with hematological malignancies during 2018-2022 were included in our study, while age- and sex-matched apparently healthy children served as controls. All study participants were Caucasian and residents of Greece. Scalp hair cortisol, which each 1 cm approximates the last month’s cortisol production as the mean value, was analyzed by using automated Electrochemiluminescense immunoassay “Cortisol II” on the automated analyzer Cobas e411-ROCHE DIAGNOSTICS (GmbH, Mannheim). Results: Thirty-four patients with hematological malignancies, aged 1-18 years (9.32± 4.60), 20/34 male, were included in this study, 21 with Acute lymphoblastic leukemia, 1 with Chronic myeloid leukemia, 5 with Hodgkin lymphoma, 6 with Non-Hodgkin lymphoma. Fifty apparently healthy children (age: 9.42 ± 3.73), 24/50 male served as controls. The ROUT test for outliers (Q (maximum false discovery rate)=1%) identified 1 outlier in controls and 6 outliers in the hematological malignancy group, leaving in total 49 control individuals and 28 hematological patients. The comparison of the hair cortisol between the two groups, after the rout test for outliers, revealed that children with hematological malignancies had lower hair cortisol concentrations compared with the control group (p-value 0.049, Mann-Whitney U test). Summary/Conclusion: Low hair cortisol concentrations levels were determined in patients with hematological malignancies compared with control group (p-value 0.049). The last 1 cm of hair, close to the scalp, reflect the patient’s cortisol concentration during the last month. The low hair cortisol concentrations in our study, reflect a possible downregulation of cortisol response to the stress of the disease. Maybe, the last months before the diagnosis of the hematological malignancies, the neoplastic cells suppress the patient’s immune system to achieve their expansion. Further studies are needed to elucidate the suppression of the stress system caused from the disease. Keywords: Childhood